K—Rod动态固定治疗腰椎间盘突出症39例报告

目的评价髓核摘除联合K-Rod动态固定治疗腰椎间盘突出症的临床疗效及影像学变化。方法2009年1月至2011年11月，对39例单节段或双节段腰椎间盘突出症患者分别采用髓核摘除联合K-Rod动态固定（A组，19例）和经椎间孔椎体间融合（transforaminallumbarinterbodyfusion，TLIF）（B组，20例）治疗。两组患者一般资料比较差异无统计学意义（P＞0.05），有可比性。手术前后采用疼痛视觉模拟评分（visualanaloguescale，VAS）及Oswestry功能障碍指数（oswestrydisabilityindex，ODI）进行比较评价，并动态观察术后责任椎间隙高度及腰椎活动度变化情况。结果A组随访时间18～32个月，平均22个月；B组随访时间18～37个月，平均23个月。末次随访两组患者腰腿痛症状明显改善。A组末次随访时VAS为1.16±0.50，ODI为（3.72±3.63）%，较术前VAS5.52±1.58及ODI（50.83±20.28）%有明显降低（P＜0.001）；B组末次随访时VAS为2.13±0.69，ODI为（18.61±4.07）%，较术前VAS6.50±1.21及ODI（60.56±9.92）%有明显降低（P＜0.001）。A组术后手术节段ROM减小，但末次随访时已恢复至术前近60%，B组术后手术节段将为0°。两组相邻节段及腰椎总活动度维持在术前水平。A组末次随访时手术节段椎间隙高度较术前降低约10%，但术后维持在一个较稳定的水平。两组相邻椎间隙高度无明显差异。两组均未见内固定松动、物断裂等情况。结论与融合相比，K-Rod系统保留了腰椎生理曲度和固定节段的活动度，对相邻节段退变无明显影响，短期临床疗效满意，长期疗效有待进一步观察。

A clinical report of K-Rod dynamic stabilization for 39 lumbar disc protrusion cases

Objective To evaluate the clinical outcomes and imaging changes of discectomy combined with K-Rod dynamic stabilization for lumbar disc protrusion. Methods From January 2009 to November 2011, 39 patients with one- or two-level lumbar disc protrusion were surgically treated by discectomy combined with K-Rod dynamic stabilization （ group A, n=19 ） and transforaminal lumbar interbody fusion （ TLIF ） （ group B, n=20 ） respectively. There were no significant differences in the general data between the 2 groups （≥0.05 ）, which were comparable. The surgical results were assessed by the visual analogue scale （ VAS ） scores and oswestry disability index （ ODI ） before and after the operation. The disc space height and lumbar range of motion （ ROM ） were measured dynamically after the operation. Results The patients of group A were followed up for an average of 22 months （ range; 18-32 months ）. The patients of group B were followed up for an average of 23 months （ range; 18-37 months ）. All the symptoms of back and leg pain in both groups were notably improved in the latest follow-up. Preoperatively the VAS scores and ODI were 5.52±1.58 and （ 50.83±20.28 ） % respectively in group A, whereas in the latest follow-up the VAS scores and ODI were 1.16±0.50 and （ 3.72±3.63 ） % respectively, which were obviously reduced （ P〈0.001 ）. Preoperatively the VAS scores and ODI were 6.50±1.21 and （ 60.56±9.92 ） % respectively in group B, whereas in the latest follow-up the VAS scores and ODI were 2.13＋0.69 and （ 18.61±4.07 ） % respectively, which were obviously reduced （ P〈0.001 ）. The ROM of operated segments in group A was reduced postoperatively, which was recovered to 60% of its original condition in the latest follow-up. However, the ROM of operated segments in group B became 0~ postoperatively. In both groups, the ROM of adjacent segments and the overall ROM of the lumbar maintained at the preoperative level. The disc space height of operated segments in group A was decreased by 10% in the latest follow-up, when compared with the preoperative value, while it maintained at a relatively stable level after the operation. There were no significant differences in the disc space height of adjacent segments between the 2 groups. There were no implant failures, such as looseness or breakage in the fixation system in both groups. Conclusions When compared with fusion, the K-Rod system keeps lumbar physiological curvature and preserves the ROM of involved segments, which has no obvious effects on adjacent segment degeneration, with satisfactory short-term clinical outcomes. However, further observation is needed to evaluate its long-term effects.